Browsing by Author "Wanyenze, Rhoda"
Now showing 1 - 11 of 11
Results Per Page
Sort Options
Item Characterising people who inject drugs, and association with HIV infection: A situation analysis in Kampala City, Uganda(PLOS Global Public Health, 2025-02-26) Mudiope, Peter; Nangendo, Joanita; Mutyaba, Samuel; Mutamba, Byamah B.; Nanyenya, Nicholus; Makumbi, Fredrick; Laker-Oketta, Miriam; Wanyenze, RhodaUganda implements interventions for injection drug use, but significant barriers hinder efforts to effectively reach and support persons who inject drugs (PWID). We describe characteristics of PWID, and associated risk behaviour, to inform the designing of programmes that are tailored to clients’ needs and preferences. A cross-sectional survey (August 23rd to December 5th, 2023) in Kampala interviewed 354 PWID (≥18-years) at selected venues(bars,lodges, street corners and ghetto). Peer eductors and counsellors administered a structured questionnaire covering socio-demographics, drug use, sexual risk, and medical history. HIV serostatus was determined by self-report or testing for consenting participants without history of recent testing Binary logistic regression was used to establish the relationship between HIV infection and risky drug- and sexual behaviour of PWID. Participants were predominantly Ugandan (95.2%), male (73.2%), unmarried (55.9%), unemployed (81.8%), with higher levels of education and varying ages. Mental disorders were prevalent, with 48.7% reporting at least one underlying condition, including depression (30.8%) and anxiety (9.6%). Physical health issues included fever (32.9%), cough (32.5%), malaria (22%), and sexually transmitted infections (15%). Over 82.6% were introduced to drugs by close acquaintances. HIV prevalence among participants was 3.7%, higher in females (8.4%) and non-Ugandans (16.7%). Being female and experiencing difficulty accessing sterile injection materials were associated with HIV-positive status. Our study provides valuable insight into the socio-demographic, mental, physical health, and HIV risk behaviour of PWID in Kampala, Uganda. The findings indicate significant vulnerabilities to injecting drug use, mental disorders, and high-risk behaviors that predispose this population to HIV infection. Despite a low HIV prevalence in this population compared to previous estimates, the interplay between drug use, risky injecting practices, and sexual behaviour suggests an urgent need for targeted interventions to address these intertwined challenges.Item The Costs And Effectiveness Of Four HIV Counseling And Testing Strategies In Uganda(Aids, 2009) Menzies, Nick; Abang, Betty; Wanyenze, Rhoda; Nuwaha, Fred; Mugisha, Balaam; Coutinho, Alex; Bunnell, Rebecca; Mermin, Jonathan; Blandford, John M.HIV counseling and testing (HCT) is a key intervention for HIV/AIDS control, and new strategies have been developed for expanding coverage in developing countries. We compared costs and outcomes of four HCT strategies in Uganda.A retrospective cohort of 84 323 individuals received HCT at one of four Ugandan HCT programs between June 2003 and September 2005. HCT strategies assessed were stand-alone HCT; hospital-based HCT; household-member HCT; and door-to-door HCT.We collected data on client volume, demographics, prior testing and HIV diagnosis from project monitoring systems, and cost data from project accounts and personnel interviews. Strategies were compared in terms of costs and effectiveness at reaching key population groups.Household-member and door-to-door HCT strategies reached the largest proportion of previously untested individuals (>90% of all clients). Hospital-based HCT diagnosed the greatest proportion of HIV-infected individuals (27% prevalence), followed by stand-alone HCT (19%). Household-member HCT identified the highest percentage of discordant couples; however, this was a small fraction of total clients (<4%). Costs per client (2007 USD) were $19.26 for stand-alone HCT, $11.68 for hospital-based HCT, $13.85 for household-member HCT, and $8.29 for door-to-door-HCT.All testing strategies had relatively low per client costs. Hospital-based HCT most readily identified HIV-infected individuals eligible for treatment, whereas home-based strategies more efficiently reached populations with low rates of prior testing and HIV-infected people with higher CD4 cell counts. Multiple HCT strategies with different costs and efficiencies can be used to meet the UNAIDS/WHO call for universal HCT access by 2010.Item The costs and effectiveness of four HIV counseling and testing strategies in Uganda(Lippincott Williams & Wilkins., 2009) Menziesa, Nick; Abang, Betty; Wanyenze, Rhoda; Nuwaha, Fred; Mugisha, Balaam; Coutinhoh, Alex; Bunnelli, Rebecca; Mermini, Jonathan; Blandford, John M.HIV counseling and testing (HCT) is a key intervention for HIV/AIDS control, and new strategies have been developed for expanding coverage in developing countries. We compared costs and outcomes of four HCT strategies in Uganda. Design: A retrospective cohort of 84 323 individuals received HCT at one of four Ugandan HCT programs between June 2003 and September 2005. HCT strategies assessed were stand-alone HCT; hospital-based HCT; household-member HCT; and door-to-door HCT. Methods: We collected data on client volume, demographics, prior testing and HIV diagnosis from project monitoring systems, and cost data from project accounts and personnel interviews. Strategies were compared in terms of costs and effectiveness at reaching key population groups. Results: Household-member and door-to-door HCT strategies reached the largest proportion of previously untested individuals (>90% of all clients). Hospital-based HCT diagnosed the greatest proportion of HIV-infected individuals (27%prevalence), followed by stand-alone HCT (19%). Household-member HCT identified the highest percentage of discordant couples; however, this was a small fraction of total clients (<4%). Costs per client (2007 USD) were $19.26 for stand-alone HCT, $11.68 for hospital-based HCT, $13.85 for household-member HCT, and $8.29 for door-to-door-HCT. Conclusion: All testing strategies had relatively low per client costs. Hospital-based HCT most readily identified HIV-infected individuals eligible for treatment, whereas home-based strategies more efficiently reached populations with lowrates of prior testing and HIV-infected people with higher CD4 cell counts. Multiple HCT strategies with different costs and efficiencies can be used to meet the UNAIDS/WHO call for universal HCT access by 2010.Item Factors Associated with Utilisation of Couple HIV Counselling and Testing Among HIV‑Positive Adults in Kyoga Fishing Community Uganda, May 2017: Cross Sectional Study(AIDS and behavior, 2020) Nakiire, Lydia; Kabwama, Steven; Majwala, Robert; Kusiima Bbale, Joy; Makumbi, Issa; Kalyango, Joan; Kihembo, Christine; Masiira, Ben; Bulage, Lilian; Kadobera, Daniel; Riolexus Ario, Alex; Nsubuga, Peter; Wanyenze, RhodaCouple HIV counseling and testing (CHCT) is key in preventing heterosexual HIV transmission and achievement of 90-90- 90 UNAIDS treatment targets by 2020. We conducted secondary data analysis to assess utilization of CHCT and associated factors using logistic regression. 58/134 participants (49%) had ever utilized CHCT. Disclosure of individual HIV results to a partner [aOR = 16; 95% CI: (3.6–67)], residence for > 1 < 5 years [aOR = 0.04; 95% CI (0.005–0.33)], and none mobility [aOR = 3.6; 95% CI (1.1–12)] were significantly associated with CHCT. Age modified relationship between CHCT and disclosure (Likelihood-ratio test LR chi2 = 4.2 (p value = 0.041). Disclosure of individual HIV results with a partner and residence for more than 1 year improved utilization of CHCT; mobility reduced the odds of CHCT. Interventions should target prior discussion of individual HIV results among couples and mobile populations to increase CHCT.Item FluNet: An AI-Enabled Influenza-Like Warning System(IEEE sensors journal, 2021) Ward, Ryan J.; Jjunju, Fred Paul Mark; Kabenge, Isa; Wanyenze, Rhoda; Griffith, Elias J.; Banadda, Noble; Taylor, Stephen; Marshall, AlanInfluenza is an acute viral respiratory disease that is currently causing severe financial and resource strains worldwide. With the COVID-19 pandemic exceeding 153 million cases worldwide, there is a need for a low-cost and contactless surveillance system to detect symptomatic individuals. The objective of this study was to develop FluNet, a novel, proof-of-concept, low-cost and contactless device for the detection of high-risk individuals. The system conducts face detection in the LWIR with a precision rating of 0.98, a recall of 0.91, an F-score of 0.96, and a mean intersection over union of 0.74 while sequentially taking the temperature trend of faces with a thermal accuracy of ± 1 K. In parallel, determining if someone is coughing by using a custom lightweight deep convolutional neural network with a precision rating of 0.95, a recall of 0.92, an F-score of 0.94 and an AUC of 0.98. We concluded this study by testing the accuracy of the direction of arrival estimation for the cough detection revealing an error of ± 4.78 . If a subject is symptomatic, a photo is taken with a specified region of interest using a visible light camera. Two datasets have been constructed, one for face detection in the LWIR consisting of 250 images of 20 participants’ faces at various rotations and coverings, including face masks. The other for the real-time detection of coughs comprised of 40,482 cough / not cough sounds. These findings could be helpful for future low-cost edge computing applications for influenza-like monitoring.Item Implementation of tuberculosis infection control in health facilities in Mukono and Wakiso districts, Uganda(BMC Infectious Diseases, 2013) Buregyeya, Esther; Nuwaha, Fred; Verver, Suzanne; Criel, Bart; Colebunders, Robert; Wanyenze, Rhoda; Kalyango, Joan N; Katamba, Achilles; Mitchell, Ellen MHTuberculosis infection control (TBIC) is rarely implemented in the health facilities in resource limited settings. Understanding the reasons for low level of implementation is critical. The study aim was to assess TBIC practices and barriers to implementation in two districts in Uganda. Methods: We conducted a cross-sectional study in 51 health facilities in districts of Mukono and Wakiso. The study included: a facility survey, observations of practices and eight focus group discussions with health workers. Results: Quantitative: Only 16 facilities (31%) had a TBIC plan. Five facilities (10%) were screening patients for cough. Two facilities (4%) reported providing masks to patients with cough. Ventilation in the waiting areas was inadequate for TBIC in 43% (22/51) of the facilities. No facility possessed N95 particulate respirators. Qualitative: Barriers that hamper implementation of TBIC elicited included: under-staffing, lack of space for patient separation, lack of funds to purchase masks, and health workers not appreciating the importance of TBIC. Conclusion: TBIC measures were not implemented in health facilities in the two Ugandan districts where the survey was done. Health system factors like lack of staff, space and funds are barriers to implement TBIC. Effective implementation of TBIC measures occurs when the fundamental health system building blocks -governance and stewardship, financing, infrastructure, procurement and supply chain management are in place and functioning appropriately.Item Routine HIV testing: the right not to know versus the rights to care, treatment and prevention(World Health Organization, 2007) Kamya, Moses R.; Wanyenze, Rhoda; Namale, Alice S.In their article “Desperately seeking targets: the ethics of routine HIV test- ing in low-income countries” published in the Bulletin in January 2006, Stuart Rennie & Frieda Behets explore some of the ethical challenges of routine (“opt-out”) HIV testing in low-income countries.1 They argue that such test- ing policies violate human rights since patients do not have sufficient liberty to say “no”. In response, we would like to draw attention to the high unmet demand for HIV testing, share our experiences in providing routine HIV testing and counselling (RTC) and discuss the ethical balance between the right not to know one’s serostatus and the rights to care and prevention.Item Sexual Risk Behavior in HIV‑Uninfected Pregnant Women in Western Uganda(Archives of Sexual Behavior, 2021-10-13) Theuring, Stefanie; Kenyonyozi, Rubagumya; Rubaihayo, John; Wanyenze, RhodaOur aim was to identify sexual risk behavior among HIV-negative pregnant women in Kabarole District, Uganda, by conducting a cross-sectional study among 1610 women within three healthcare settings. One in six women engaged in HIV-specific risk behaviors including multiple sexual partners or alcohol abuse; 80% of the pregnant women reported to generally abstain from using condoms. In multivariate analysis, predictors of sexual risk behavior included being a client of the public health facilities as compared to the private facility (AOR 3.6 and 4.8, p < 0.001), being single, widowed or divorced or not cohabiting with the partner (AOR 4.7 and 2.3, p < 0.001), as well as higher household wealth (AOR 1.8, p < 0.001) and lack of partner status knowledge (AOR 1.6, p = 0.008). Self-estimated risk perception was linked with engagement in HIV-related risk behaviors except for alcohol abuse. Our findings indicate that reducing risky behaviors in pregnancy in order to prevent HIV should be a high-priority public health concern.Item Socio-demographic predictors of gender inequality among heterosexual couples expecting a child in south-central Uganda.(African Health Sciences, 2020-09) Vrana-Diaz, Caroline J.; Korte, Jeffrey E.; Gebregziabher, Mulugeta; Richey, Lauren; Selassie, Anbesaw; Sweat, Michael; Chemusto, Harriet; Wanyenze, RhodaBackground: Gender inequality is a pervasive problem in sub-Saharan Africa, and has negative effects on health and de- velopment. Objective: Here, we sought to identify socioeconomic predictors of gender inequality (measured by low decision-making power and high acceptance of intimate partner violence) within heterosexual couples expecting a child in south-central Uganda. Method: We used data from a two-arm cluster randomized controlled HIV self-testing intervention trial conducted in three antenatal clinics in south-central Uganda among 1,618 enrolled women and 1,198 male partners. Analysis included Cochran Mantel-Haenzel, proportional odds models, logistic regression, and generalized linear mixed model framework to account for site-level clustering. Results: Overall, we found that 31.1% of men had high acceptance of IPV, and 15.9% of women had low decision-making power. We found religion, education, HIV status, age, and marital status to significantly predict gender equality. Specifically, we observed lower gender equality among Catholics, those with lower education, those who were married, HIV positive women, and older women. Conclusion: By better understanding the prevalence and predictors of gender inequality, this knowledge will allow us to better target interventions (increasing education, reducing HIV prevalence in women, targeting interventions different reli- gions and married couples) to decrease inequalities and improve health care delivery to underserved populations in Uganda.Item Socio-economic determinants of HIV testing and counselling: a comparative study in four African countries(Tropical Medicine and International Health, 2013) Obermeyer, Carla M.; Neuman, Melissa; Hardon, Anita; Desclaux, Alice; Wanyenze, Rhoda; Ky-Zerbo, Odette; Namakhoma, Ireen; Cherutich, PeterResearch indicates that individuals tested for HIV have higher socio-economic status than those not tested, but less is known about how socio-economic status is associated with modes of testing. We compared individuals tested through provider-initiated testing and counselling (PITC), those tested through voluntary counselling and testing (VCT) and those never tested. methods Cross-sectional surveys were conducted at health facilities in Burkina Faso, Kenya, Malawi and Uganda, as part of the Multi-country African Testing and Counselling for HIV (MATCH) study. A total of 3659 clients were asked about testing status, type of facility of most recent test and socio-economic status. Two outcome measures were analysed: ever tested for HIV and mode of testing. We compared VCT at stand-alone facilities and PITC, which includes integrated facilities where testing is provided with medical care, and prevention of mother-to-child transmission (PMTCT) facilities. The determinants of ever testing and of using a particular mode of testing were analysed using modified Poisson regression and multinomial logistic analyses. results Higher socio-economic status was associated with the likelihood of testing at VCT rather than other facilities or not testing. There were no significant differences in socio-economic characteristics between those tested through PITC (integrated and PMTCT facilities) and those not tested. conclusions Provider-initiated modes of testing make testing accessible to individuals from lower socio-economic groups to a greater extent than traditional VCT. Expanding testing through PMTCT reduces socio-economic obstacles, especially for women. Continued efforts are needed to encourage testing and counselling among men and the less affluent.Item Women’s views on consent, counseling and confidentiality in PMTCT: a mixed-methods study in four African countries(BMC Public Health, 2012) Hardon, Anita; Vernooij, Eva; Bongololo-Mbera, Grace; Cherutich, Peter; Desclaux, Alice; Kyaddondo, David; Ky-Zerbo, Odette; Neuman, Melissa; Wanyenze, Rhoda; Obermeyer, CarlaAmbitious UN goals to reduce the mother-to-child transmission of HIV have not been met in much of Sub-Saharan Africa. This paper focuses on the quality of information provision and counseling and disclosure patterns in Burkina Faso, Kenya, Malawi and Uganda to identify how services can be improved to enable better PMTCT outcomes. Methods: Our mixed-methods study draws on data obtained through: (1) the MATCH (Multi-country African Testing and Counseling for HIV) study’s main survey, conducted in 2008-09 among clients (N = 408) and providers at health facilities offering HIV Testing and Counseling (HTC) services; 2) semi-structured interviews with a sub-set of 63 HIV-positive women on their experiences of stigma, disclosure, post-test counseling and access to follow-up psycho-social support; (3) in-depth interviews with key informants and PMTCT healthcare workers; and (4) document study of national PMTCT policies and guidelines. We quantitatively examined differences in the quality of counseling by country and by HIV status using Fisher’s exact tests. Results: The majority of pregnant women attending antenatal care (80-90%) report that they were explained the meaning of the tests, explained how HIV can be transmitted, given advice on prevention, encouraged to refer their partners for testing, and given time to ask questions. Our qualitative findings reveal that some women found testing regimes to be coercive, while disclosure remains highly problematic. 79% of HIV-positive pregnant women reported that they generally keep their status secret; only 37% had disclosed to their husband. Conclusion: To achieve better PMTCT outcomes, the strategy of testing women in antenatal care (perceived as an exclusively female domain) when they are already pregnant needs to be rethought. When scaling up HIV testing programs, it is particularly important that issues of partner disclosure are taken seriously.